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Sunday, April 28, 2013

Do Cloth Diapers Really Delay Walking?

I'd like to comment on a recent study from the Journal of Developmental Science entitled "Go Naked: Diapers affect Infant Walking".
The article is meant to highlight diapers as a possible source of
variation in studies on infant mobility. Walking was analyzed while
children were walking naked, while wearing a disposable diaper, or while
wearing a cloth diaper. While it is not
stated outright, the article potentially suggests that cloth diapered
children may have delayed walking skills compared to disposable diapered peers. This possibility has created quite the controversy among cloth diapering parents.

Today I'll share my opinions on the results of these studies. I noted several aspects of study design that could have altered the results using cloth diapers:

1. Almost all participants are new to cloth diapers

90%
of 13-month-olds and 93.3% of 19-month-olds in this study
normally wore disposable diapers. This indicates that most infants
hadn't had previous experience wearing cloth diapers. The investigators
argue that the novelty of wearing cloth diapers wasn't a factor in
their results. They noted that most infants in the study hadn't had
experience walking naked, yet walking naked was easiest for
participants. However, I think this assumption is overstated. It's not
as if children have never been naked, yet wearing a cloth
diaper is an entirely new experience. An exclusively disposable
diapered child would likely react differently when placed into a foreign
type of diaper.

2. Type of cloth diapers selected is not representative

The
specific type of cloth diaper used in this study was not specified;
however, it was noted that cloth diapers were folded, indicating that
they were either prefold or flat style diapers. I found it surprising
that for a study published in 2012, a more modern style of diaper was
not selected. In the 2012 Cloth Diaper Pulse Survey from Diapers Shops,
only 16% of cloth diapering parents reported that traditional flat or
prefold diapers were their preferred choice of cloth diaper. Over 50%
of parents reported preferring "pocket" style diapers: a modern and
trim-fitting variety of cloth diaper that does not involve folding. The
traditional variety of cloth diaper used in this study does not
accurately reflect the type of cloth diaper commonly used by today's
cloth diapering parent. Images in the article comparing walking while
wearing the different varieties of diapers show a child wearing an
extremely bulky cloth diaper that is not commonly used by the cloth
diapering community.

Modern "Pocket" diaper is trim-fitting and less bulky than traditional cloth diapers

3. Cloth Diapers were folded for "night time" use

This
study noted that cloth diapers were folded for "night time use" when
they were put on the babies. Cloth diapering parents who commonly use
traditional cloth diapers, know there are a variety of ways to fold
diapers. Each particular fold has benefits and drawbacks, and a night
time fold would not be selected for daytime use. Folds like "bikini
twist" create very little bulk between the legs and are a preferred
choice for during the day. Night time folds would be selected for
absorbancy instead of comfort while walking. Therefore, the study used a
diaper fold that would be used during a time when the child was not
ambulating.

4. Small sample size

Small
numbers of participants seems to plague many human studies, and I
couldn't do a review without at least mentioning that this is a small
study. With only 30 participants per age group and data being removed
due to non-cooperative babies, we have to use extreme care when talking
about the results. A larger study with more children, more ethnic
diversity, and more cloth diapered babies may have had a different
outcome.

5. Babies are only tested in dry diapers

This
study only looked at the effects of walking in dry diapers. A wet
disposable diaper can quickly become bulky and heavy. Since many
parents leave children in disposable diapers for more than two hours,
children would commonly be ambulating in an expanded diaper.

Statements that potentially cause confusion:

"Possibly,
infants who learn to walk while naked—without the additional
challenge posed by a diaper—might show more rapid gains
in posture and coordination, facilitating earlier onset ages
and faster improvements. This would be consistent with
reported historical changes in infant walking:
Infants today walk sooner and better than those of previous
generations, when all infants wore cloth diapers (Shirley, 1931)."

This statement gives the reader the impression that the cultural shift to disposable diapers has, in some way, facilitated earlier walking in infants. However, there are far too many factors to make a correlation between walking and diapering. As one example; infants today are generally born larger than they were in the 1930s, and larger babies may walk earlier than smaller babies.

Conclusions

I found
the results of the naked walking vs. walking with a diaper story to be
very interesting in this study. The authors are clearly experts in
infant mobility and wanted to ask the question: "Do children walk
differently in diapers vs without diapers?" I feel that the cloth
diaper vs. disposable diaper story was not complete and may have given
parents an incorrect perception that cloth diapers limit development of
walking skills. Parents are extremely sensitive to comparisons between
children, and misinterpreting the results of this study may make some
parents decline to give cloth diapering a try. I was disappointed that
cloth diapers were represented as old fashioned and bulky: stereotypes
that do not accurately reflect attributes of modern cloth diapers. I
think it is important to keep in mind that Proctor and Gamble (makers of
Pampers) did contribute funding to this work.

With
the multitude of factors affecting infant walking, plus the new variety
of cloth diapers available, cloth diapering parents can rest assured
that their choice of diaper is not detrimental to their children.
However, I would suggest that parents do give their children
opportunities to have diaper-free time based on the findings of this
study. We know that diaper-free time is not only great for preventing
rashes and encouraging potty training, but it helps children move their bodies without restriction.

The
opinions expressed in this review are my own. As with all scientific
review, my intent is to provide positive criticism and further our
understanding of the research. I feel
qualified to review the scientific content of this article based on my
PhD in biomedical research, and my current work studying movement
disorders. I am also a
parent who has exclusively cloth diapered two children.

10 comments:

You really hit the ball out of the park on this one, Nissa! This is extremely well-researched and I like how you critically examine the methods used in the study, as well as the conclusions that were made. And I'm still not even convinced that walking sooner is necessarily a better thing, and something parents should worry about. In the grand scheme of things, does it really matter whether a toddler starts walking at 12 months instead of 14 months? - Anne

Absolutely! I remember we felt a similar way about our daughter and learning to crawl. We had been trying to sell our house and couldn't have baby gates up. She was a late crawler and finally took off like mad at 10 months just as we were moving out. It was such a relief that she wasn't able to get into things and potentially get hurt while we were in the middle of packing.

My son is 14 months, just started taking his first steps this week! He didn't pull to standing until 13 months. He is a bit behind in gross motor skills, but I would not contribute this delay to cloth diapers!

Both of my boys walked earlier than some of their friends in their play group that wore disposables. It is also sad that P&G had funded the study, because I think that it was also them that funded a study about the effects of cloth on the environment and even went as far as to say that disposables were biodegrade-able (would share the youtube video of their commercials, but has long since been removed).

It is so important to look at "research" from all different angles, and you did a fabulous job!

P&G are certainly getting a run for their money with some many people switching to cloth. It's just so smart! I really feel for my friends using disposables because they are calculating the cost for every diaper they use on the children. It's just not sustainable on so many levels.

Thanks again for your analyzing, Nissa! As you know, my daughter S is 21 months old and exclusively cloth diapered (except during my little experiment and during her PT therapy hour) and still not walking. I think that I am one of the many parents out there who felt like their choices could impact the mobility of their child, and I felt terrible. I now feel more confident after experimenting and reading your review. Thanks again!,Audrey

I'm so glad this was helpful for you. I'm sure there are many other parents who were questioning their decision to cloth diaper after reading this potentially misleading data. Hopefully your little one will take off walking soon! There are so many factors as to when a child takes those first steps. Our daughter also took her time walking. For us, a big help was transitioning to a daycare room where most of her peers were walking: after that she finally got the confidence to start pulling herself up and trying for those first steps.